Strong Response To Mental Stress Could Indicate Heart Disease

December 16, 1997

An exaggerated response to mental stress could be a marker for future heart disease among people under age 60 with a strong family history of premature heart disease, according to a study by Johns Hopkins researchers.

This study was the first to link an exaggerated response to mental stress with signs of early heart disease in an apparently healthy group of people with brothers and sisters who had premature heart disease. Study participants who responded strongly to mental stress tests were likely to have silent coronary ischemia during exercise, indicating a lack of adequate blood flow to the heart.

Results of the study, supported by the National Institutes of Health, were published in the Dec. 16 issue of Circulation.

"People have long believed that stress is a leading cause of heart disease, but until now we've had very little direct evidence that this was true," says Brian G. Kral, the study's lead author and a graduate student at Hopkins. "This study is one of the first to show actual blood flow decreases in the hearts of people who are hot responders' to stressful events."

Researchers studied 152 siblings, ages 30 to 59, of people with premature heart disease. While these people showed no apparent signs of heart disease, they had a high prevalence of coronary risk factors. Forty-six percent had high blood pressure, 33 percent were smokers and 53 percent were obese.

All study participants had their heart rate and blood pressure measured during mental stress tests. They also completed a treadmill and thallium exercise test to measure blood flow to the heart during exertion.

The siblings who developed ischemia during exercise (15 of the 152) had significantly greater increases in blood pressure compared with siblings who had normal exercise tests.

Further analysis showed that the siblings who developed ischemia during exercise tests were 21 times more likely to be "hot responders" to mental stress.

The study's other authors were Lewis C. Becker, M.D.; Roger S. Blumenthal, M.D.; Thomas Aversano, M.D.; Lee A. Fleisher, M.D.; Raphael M. Yook, M.S.P.H.; and principal investigator Diane M. Becker, Sc.D., M.P.H. The study was supported by the National Heart, Lung and Blood Institute and the National Institute of Nursing Research.


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Johns Hopkins Medicine

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